Active NPI
Jericho Fulache
- Physical Therapist
- Arcadia, CA
National Provider Identifier
1376211706
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 300829
- Practice address
- 5522 Gracewood Ave
Arcadia, CA 91007-8409 - Phone
- (626) 579-0310
- NPI assigned
- Aug 31, 2021
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 300829 | CA | Primary |
Addresses
Primary practice location
5522 Gracewood Ave
Arcadia, CA 91007-8409
Mailing address
3208 Hacienda Dr
Duarte, CA 91010-2313
Phone (626) 298-1328
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1630368000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1630368000000",
"number": "1376211706",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3208 HACIENDA DR",
"city": "DUARTE",
"state": "CA",
"postal_code": "910102313",
"telephone_number": "626-298-1328"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5522 GRACEWOOD AVE",
"city": "ARCADIA",
"state": "CA",
"postal_code": "910078409",
"telephone_number": "626-579-0310"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FULACHE",
"first_name": "JERICHO",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-08-31",
"last_updated": "2021-08-31",
"certification_date": "2021-08-31",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CA",
"license": "300829",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Arcadia, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.